New Mexico Health Insurance Exchange (NMHIX)

Written by Erica Manfred
| Published on October 10, 2013Medically Reviewed by George Krucik, MD, MBA
on November 12, 2013

New Mexico

Overview of New Mexico’s Health Insurance Exchange

When the Affordable Care Act was passed in 2010, states gained the
opportunity to build health insurance marketplaces called exchanges. The New
Mexico Health Insurance Exchange (NMHIX) is New Mexico’s marketplace, and Be Well NM is the web portal for the program.
This program will help people who are unable to buy their employer insurance
plans, as well as those who are uninsured or buying their own insurance.

NMHIX is offering plans from the following providers: Blue
Cross and Blue Shield of New Mexico, Lovelace, Molina, New Mexico Health
Connections, and Presbyterian Health Plan. Several low- and mid-priced plans
are offered.

Small businesses and individuals can start
shopping/enrolling starting October 1, 2013. Employees of the small business
employers setting up insurance through the Small Business Health Options
Program (SHOP) site are able to begin enrolling on November 1, 2013

Open enrollment lasts until March 1, 2014. Your plan
will be effective on January 1, 2014. There will be healthcare guides who can
help you with any issues you have in the healthcare search and enrollment
process. You can also consult an insurance agent or broker. The NMHIX call
center is live 24 hours a day and seven days a week.

Per the Affordable Care Act, all plans have to offer the following essential
services:

Rehabilitative
and habilitative services and devices (Habilitative services are for people
with disabilities who need speech, occupational, or physical therapy.)

Laboratory
services

Preventive
and wellness services and chronic disease management

Pediatric
services, including oral and vision care

Costs

There are four basic plans available with varying levels of coverage:
Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80
percent), and Platinum (90 percent). Lower plans have lower premiums, but
higher out-of-pocket costs. A catastrophic plan is available for folks under
the age of 30. This plan has a high deductible.

Adults livings at or below 133 percent of the federal poverty level (also
known as the FPL, which is $11,490 a year in wages for one person and $23,550 a
year in wages for a family of four), or pregnant women living at or below 250
percent of the FPL, can qualify for Medicaid in New Mexico, based on
eligibility standards that will take effect January 1, 2014.

Additional federal financial protections will start in 2015
that include a maximum annual out-of-pocket cost of $6,350 for individuals and
$12,700 for families. Capping out-of-pocket costs will help consumers pay
medical bills that aren’t covered by insurance, reducing the chance of
bankruptcy.

Tax credits are based on the Silver Plan, so you can easily
determine what your additional out-of-pocket costs will be if you elect a
higher or lower plan compared to Silver. The Affordable Care Act (ACA) was
designed so the Silver Plan would be affordable to people who had to buy their
own insurance, regardless of how expensive the healthcare rates may be where
they live.

The two lowest-cost Silver Plans in New Mexico for a 40-year-old are $189
and $212 per month.

Individuals and families with incomes less than 400 percent
of the federal poverty level (who are covered by an exchange plan) are eligible
for healthcare tax credits. The payment of credits will begin in 2014.

People want to how much their subsidies are, but the real question
is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income,
then you know that's the most you'll have to pay for a Silver Plan (you
may pay less). For example, if your income is $32,500 a year
(283 percent of the poverty level), the most you’ll have to pay for health
insurance is nine percent of your income, which amounts to $2,926 a year, or
$244 a month. The challenge is to look at the costs of the Bronze, Silver, Gold, and Platinum plans, and decide which plan offers the best value for you.

Information
on Subsidies

For estimating any possible premium assistance,
BeWellNM.com hosts the free Subsidy Calculator created by the Kaiser Family Foundation. Once live,
NMHIX also will offers online Q&A to address specific questions, in
addition to its call center for customers.

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